Behavioral health was the biggest health care crisis Americans faced going into the pandemic, and it will easily be the biggest one faced coming out of it, according to Arkansas Blue Cross and Blue Shield President and CEO Curtis Barnett.
Curtis Barnett
Barnett uses the term behavioral health to describe both mental health conditions – such as depression, anxiety and trauma – and substance use disorders caused by overuse of drugs or alcohol.
“More than 20% of U.S. adults experience some type of behavioral health disorder, yet 60% of them don’t receive care for their condition in a given year,” Barnett said. “For millennials, who now make up our largest generation, the rate is even higher. More than one third report having a behavioral health condition, and we’re seeing rapid increases in major depression and alcohol and substance use.”
The increases in anxiety and depression reported in U.S. adults soared from 11% in January 2019 to 41% in January 2021. The highest rates, by far, were experienced by young adults between the ages of 18-24.
“More than half of parents express concern over their children’s mental well-being,” Barnett said. “One in three high school students and half of all female students report persistent feelings of sadness or hopelessness. Emergency room visits for attempted suicide have risen 51% for girls. If we’re going to help people live healthier lives – the kind of lives they deserve – and impact the rate at which health care costs are growing, we must make progress on the behavioral health front.”
To help accomplish this, Arkansas Blue Cross is making significant community and business investments.
Bo Ryall
“We started with our communities,” Barnett said. “Through our Blue & You Foundation for a Healthier Arkansas, under Rebecca Pittillo’s leadership, we spent months researching different approaches and initiatives.
“We knew that we wanted to support behavioral health in all stages of life, from early childhood, through adolescence and into adulthood. In July 2021, we committed $5.29 million to expand behavioral health resources across our state. This is the largest investment in the 20-year history of our foundation.”
Barnett said recently they’ve turned their attention to business investments and how they can better help their customers and members meet their behavioral health needs. Some of the features of this new approach include:
• Improving access by expanding their telehealth services.
• Making sure customers have the option to choose benefit plans that provide 100% coverage for a certain number or behavioral health therapy services.
• Rolling out a new digital platform that will make it easier for members to navigate the behavioral health care system.
• Continuing to support programs and processes that better integrate behavioral health and primary care, which is the best way for providing “whole person health.”
Arkansas Blue Cross, the largest health insurer in the state covering 635,425 people, took several significant actions in the early days of the pandemic, especially in offering greater flexibility and support for members, employees, communities and the state’s health care providers. Barnett said he believes those factors have allowed them to weather this public health crisis very effectively and continue to be there for members and communities in need.
“This approach also gave the provider community more flexibility in their business decisions during this difficult time,” Barnett said. “Still, like most employers, we’re still dealing with some of the longer-term effects of the pandemic, especially as they relate to a challenging labor market, rising costs due to inflation and adapting to a larger remote work environment.”
The new COVID variants are a reminder that the pandemic isn’t over. Barnett said that means they will continue to operate in a very uncertain environment, especially as it relates to future waves of COVID-19 infections and the timing of the end of the federal Public Health Emergency.
“Even in the midst of all of the uncertainty, the pandemic has rejuvenated our desire to address some of health care’s biggest issues,” he said. “Whether it was with physical health conditions – like obesity and chronic health conditions – unmet social needs, or health disparities due to geography, race or ethnicity, COVID-19 exposed parts of our population, our society and our health care system, which were already vulnerable, and made them worse.
“In response, we’re emphasizing the importance of a ‘whole person’ approach to care, which addresses a patient’s physical, behavioral and social needs together. We’ve also ramped up our efforts to impact health disparities in Arkansas through a new health equity program and strategy.”
Arkansas Blue Cross and health care providers are very concerned about the long-term health effects COVID-19 has on certain patients. Symptoms from “long COVID” often include fatigue, shortness of breath and cognitive problems (thinking and memory) that impact the person’s quality of life, health status and health care costs.
While the rate of telehealth visits has declined since the height of the pandemic in 2020, Barnett said it continues to be much higher than what was observed pre-pandemic and remains a bright spot, especially for gaining access to behavioral health services, particularly in rural areas of the state.
“Our next challenge is to continue to work to ensure telehealth is integrated within the broader health care system to ensure patients are receiving the right type of care at the right time,” he said. “We’re also seeing greater interest among health care systems to move more provider reimbursement to value-based payments rather than just traditional fee-for-service payments. Value-based payments incent improvements in quality and outcomes.”
Arkansas Blue Cross continues to be concerned about the deferral of preventive care services that have occurred over the past couple of years, as well. They have been reaching out to their members, reminding them of preventive screenings, routine examinations and immunizations.
Arkansas is one of the worst five states for oral health in the nation. The Arkansas Center for Health Improvement reported June 2 that even before the COVID-19 pandemic, most Arkansans were not making regular visits to the dentist, even if they had dental insurance. The use of dental services dropped even more during the first year of the pandemic.
Arkansas Blue Cross offers a variety of dental plans to fit different individual and family needs. Barnett said a significant focus is on preventive oral health, but plans cover restorative dental care as well. There is extra preventive coverage for special needs as well, such as oral cancer, heart conditions, pregnancy and more.
Arkansas Blue Cross and Blue Shield, an independent licensee of the Blue Cross and Blue Shield Association, was founded in 1948. Arkansas Blue Cross and its affiliates have more than 3,200 employees. The Blue Cross and Blue Shield Association is composed of 36 independent, locally operated Blue Cross and Blue Shield Plans that collectively provide health care coverage for 100 million people, nearly one in three Americans.
Concern surrounds end of ACA subsidies
Temporary Affordable Care Act (ACA) subsidies provided through the American Rescue Plan are set to expire at the end of 2022 if they are not extended by Congress. Arkansas Hospital Association President and CEO Bo Ryall says any increase in the number of people who are uninsured would have a tremendous impact on the ability of Arkansans to afford health care and on the financial stability of hospitals.
“If Congress does not take action to protect ACA subsidies, monthly premiums are projected to increase by 50% or more,” Ryall said. “This cost would be unbearable for some families, leading to a loss of insurance coverage, difficulty accessing care and eventually, worse health outcomes.”
Ryall says Arkansas hospitals are already facing unprecedented financial stress, with health care labor and supply costs outpacing inflation as a whole, and many are operating on negative margins.
“Increases in uncompensated care would put many of our most important safety net hospitals in untenable situations,” Ryall said. “Protecting the ACA subsidies is vital for Arkansas’s health care system.”
Arkansas Blue Cross and Blue Shield President and CEO Curtis Barnett says they are concerned that large increases in the member’s share of the premium may cause many of these individuals to either drop coverage or opt for coverage that requires them to pay more out-of-pocket for their care.
“We believe this would add tremendous financial stress to our members,” Barnett said.
In 2021, 87% of Arkansas Blue Cross Health Insurance Marketplace members received financial assistance. The average amount of that assistance was $699 a month. According to Barnett, nearly 21% of their members use the Marketplace in one way or another.
